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Over the past couple of years, we’ve slowly but surely seen a pretty decent rise in acknowledgement of cognitive accessibility as a primary pillar of accessibility support alongside hearing, vision, and motor accessibility categories. Covering a broad range of disabilities related to the functioning of the brain, we’ve started to see increasing numbers of game developers offering cognitive accessibility presets in their initial onboarding setups, and more efforts made to offer new types of accessibility support for those with cognitive disabilities.
As an autistic gamer myself, I’ve invested a lot of time over the past few years pitching game developers on ways that video games could be making efforts to be more accessible to the autistic community, ranging from already commonplace concepts to more experimental new ideas.
So this week, on Access-Ability, I wanted to take some time to put some of my big picture thoughts on this topic together in a single place, as a quick primer on concepts worth considering when aiming to design a game for autistic player accessibility.
Autism is a spectrum condition, so not every piece of advice given here will apply to every autistic gamer, and some options helpful to some users may not be featured, but I hope this acts as a primer for a broader discussion on the topic.
Non Verbal Subtext
I’m going to start this video by pitching a concept I’ve spent the past couple of years trying to encourage game developers to take a chance on implementing, that I think could be really useful for autistic gamers like myself who struggle with understanding non verbal subtext.
Back in September of 2020, Marvel’s Avengers was published by Square Enix. While the game itself wasn’t terribly notable in terms of accessibility, there was one scene I was fascinated with. In the scene, Kamala Khan is riding in a car with Bruce Banner – No dialogue is exchanged, but the scene plays out with Kamala slurping her near empty drink cup loudly to get a rise out of Bruce, with him rolling his eyes in annoyed response.
What made the exchange fascinating to me was that the subtitle track was used during this scene to explain the non verbal subtext of the back and forth, explaining that the slurping was deliberately intended to annoy Bruce, and that his eye movements were an exasperated response to her antagonistic actions.
This scene is one of the only times I have ever seen a video game explicitly explain non verbal subtext as text, and it was hugely useful for my understanding of the intended interpretation of the scene.
I am an advocate of the idea that a potential innovation this industry could attempt to better support autistic players is offering additional clarity for non verbal subtext. This could come in the form of a separate subtitle track, for example, presented optionally above the standard closed caption track similarly to how Senua’s Saga: Hellblade 2 used a second upper subtitle track for displaying positional auditory hallucination subtitles separate from general closed captions.
In terms of the work required to design these kinds of non verbal subtext subtitles, I believe that we could start by looking at the work currently being done to write Cinematic Audio Descriptions of cutscenes for blind players in games like The Last of Us: Part 1 Remake. These audio descriptions often already describe visual non verbal subtext textually, and some of that work could be used as the basis for a non verbal subtext subtitle track.
Cinematic Audio Descriptions already do the work of deciding how explicit or not to be in explaining uncertain facial expressions, such as describing Ellie’s facial expression at the end of The Last of Us: Part 1 without stating definitively whether or not she believes Joel. This is a great example to look at of how one might go about this type of autistic player support hypothetically.
Additionally, you could consider offering players tone tags on existing subtitles, similar to how many games offer optional speaker name tags, to state the emotion with which certain lines are being stated, to more clearly highlight things like sarcasm or audible uncertainty.
Lastly, on this topic, offering tone tags could also be really useful for games with narrative dialogue choices, particularly those that noticeably branch their narratives, to better help with understanding the tone a given answer will be delivered with, for greater clarity for autistic players.
Idioms
On a similar note, as many autistic individuals struggle with abstract turns of phrase or idioms, I would love to see any games that offer tools to confirm the meanings of in universe terms during conversations also offer the ability to look up the meanings of idioms using those same tools.
This is not a hard barrier to progression generally, autistic players in most cases can look up meanings on their phone if a game allows them the ability to pause during cutscenes and conversations, but in games where these types of glossary tools already exist it would be great to see them extended to this particular use case.
Additional Time and Information Before Choices
Many autistic individuals struggle with choice paralysis when faced with choices that we don’t feel like we have enough information to confidently navigate. This is made more common by timers on narrative choices, and difficulties understanding the unstated context of choices before making them.
Giving players the option to see additional information, such as a slightly longer explanation of what they’re going to say if they make a specific choice, can help immensely in not getting stressed overthinking an upcoming choice in a game.
Additionally, offer players the ability to extend or turn off choice timers, so they have more time to process the consequences of a choice that other non-autistic players may be able to intuit more quickly.
Sensory Dampening or Warnings
One of the ways I’m most personally impacted by being autistic on a day by day basis is my relationship with sensory sensitivity. I often find that small noises that others find easy to mentally tune out are impossible for me to ignore, or that when presented with too much sensory input overlapping at once I can become physically anxious and stressed as my brain struggles to process overlapping unfiltered input. This is not just about it being hard to pick up specifics in the chaos, it triggers a physical stress response that can spiral if not properly managed.
In terms of ways that video games can help support players with sensory oversensitivity issues like myself, I want to highlight an example of a game I worked on as an accessibility consultant that released last year, Life is Strange: Double Exposure. That game, following in the footsteps of the studio’s previous title True Colours, offered players the ability to receive on screen warnings prior to loud noises or bright light flashes appearing in game, as well as the option to decide whether these warnings would pause the game automatically or simply display a warning on screen to avoid impacting the flow of the narrative.
Additionally, many video games today offer players the option to reduce the dynamic range of audio, so that the loudest noises are more quiet and the quietest noises are slightly louder. These settings are generally advertised as a way to avoid a spike in audio volume waking anyone up if you’re gaming late at night after others are asleep, but this increased predictability of audio volumes can help hugely in preventing sensory overwhelm for autistic players.
Developers can also help reduce sensory sensitivity issues by reducing potential photosensitivity triggers in their games. This is helpful in a general sense for autistic players sensitive to visual overstimulation, but also useful in that photosensitive conditions such as epilepsy are commonly comorbid with autism, a topic we’ll circle back to later.
Lastly, you can support autistic players with sensory sensitivity by offering a multitude of audio sliders so that potential problem sounds can be made less distracting, and offering settings such as tinnitus sound toggles and misophonia modes that reduce sounds that are, coincidently, common autism sensitivity triggers.
Tools for Non-Verbal Communication
Autism as a condition is a spectrum, and can have a number of different impacts on speech and language development. While some autistic people are hyperverbal, others are completely non verbal, while others still sit somewhere along that line. Using myself as an example, I have unpredictable spells where I struggle with speech, particularly when impacted by external stress. I generally don’t struggle with verbal speech, but there are exceptions, times where I simply cannot grasp words no matter how hard I try to.
As a result of Autism’s connections to verbal communication difficulties, it’s important to offer alternatives to verbal communication where possible in online multiplayer titles.
A great example of a game with this type of support is Apex Legends, a game whose Ping System does a great job of communicating complex information about where items can be found, enemy player locations, and squad commands without needing to engage in voice chat.
One thing I would love to see the video game industry explore more going forward is ways that AAC (Augmentative and Alternative Communication) devices could be integrated into video game voice chats directly. These devices, often tablets with apps installed, allow for verbal communication using tools such as illustrated icons. While there are ways to integrate these apps with PC programs for online voice chat, I would love to see one of the major console manufacturers officially support a plugin or settings option to allow a commonly used AAC program to interface directly with in-game voice chat on their systems.
Changes in Routine
For many autistic individuals, predictable routine is a cornerstone of existence, a lifeline that helps navigate the otherwise unpredictable and chaotic nature of everyday life.
Many autistic individuals like myself develop very rigid routines as a way to navigate life – Walking the same route home from work, eating the same small selection of foods each day, listening to the same song on loop when doing specific tasks, or perhaps having clothing we wear specific days of the week.
For many autistic individuals, a change in an established routine can be a genuine source of stress and anxiety. It might be managable with enough warning time and ability to adapt the routine on our own terms, but an unexpected change to a routine can be pretty overwhelming for many of us.
In the context of video games, this can manifest in unexpected ways – For example, an online multiplayer game we’ve played every day after work having its servers shut down unexpectedly, or a game suddenly changing its mechanics in a balance patch so it no longer feels the same.
A great example of the kind of change to a game an autistic player might find difficult if surprised by would be major changes being made to the map in a game like Fortnite when a new in-game season begins. If I’ve been playing the game every day for weeks, always following a very similar route across the map, and that map suddenly no longer featured locations I remember, or having huge new features, is a change to that predictable routine that might take some time to adjust to.
For developers, the best advice I can give on this front is to request that you warn players in advance that these kinds of major changes to your game are on the way, and ideally when they’re going to happen, with enough advance notice to adapt and be mentally prepared for the change.
It might seem like a small thing, but knowing a routine change is coming can make it a lot easier to process for people who thrive on predictable routine.
The Ability to Pause
Given that many of the struggles inherent in living with autism can be boiled down to experiencing stress responses and overwhelm caused by sensory and social stimuli and a lack of predictability, one of the best ways you can support autistic players in a broad sense is to make sure your game offers the ability to pause, ideally at any time including during cutscenes.
Be it due to sensory overwhelm, or difficulty processing complex social narrative choices, offering players the ability to pause their game can give space to avoid becoming overwhelmed.
Inherently Inaccessible Genres
Some game genres are just inherently likely to contain barriers for autistic players, with a great example of this being social deduction games like Among Us. Games where players are required to communicate via voice chat, engage in deceit, and navigate complex social interactions are inherently going to be more challenging for players who struggle with communication nuance in real time.
However, these kinds of games are also often more difficult for autistic players for another reason, inherent biases in how non autistic individuals perceive autistic behaviour as inherently deceptive or deceitful due to its variance from a perceived “norm”. It’s like when you hear accounts of police assuming that autistic people taken into custody are guilty because of their lack of eye contact and flat emotional tone of voice. Sometimes aspects inherent to being autistic are perceived as signs of deception in social deduction video games.
While I’ve not seen any examples of games managing to mechanically offer a great solution to this problem, I do think there’s room for game developers to engage in conversations with their player base about this topic. If you can make your players aware that autistic people exist and might communicate in ways that differ from them, and to be aware of their existing biases, you might help reduce the frequency with which someone decides to point an accusation in these kinds of games based purely on slightly awkward speech patterns.
Remote Press Events
This is a little more inside baseball for the industry, but a lot of autistic game critics struggle with the sensory, social, and otherwise unpredictable aspects of travelling to a remote location such as a game development studio to attend hands-on preview events for games.
While not always an option, I would love to see more game developers offering options for remote attendance of press events, such as using programs such as Parsec to stream gameplay to a remote machine, with minimal lag, over a decent internet connection.
Sensory Support at Conventions
In a similar vein, I love that over the past few years Xbox has been making efforts to offer autistic attendees at video game conventions support options, such as access to a quiet room on the show floor hidden a little away, and access to ear plugs to help handle loud environments.
I would love to see conventions take things a step further by beginning to offer things like virtual queuing systems for disabled attendees, allowing them to queue for game demos without having to stand in physically crowded and sensory overwhelming lines.
Gamescom 2024 attempted a version of this, with a first come first served system for booking appointments to skip the queue for certain game demos, but a version of this expanded and specifically offered firstly to disabled attendees could be hugely helpful in avoiding burnout by allowing queuing time to be spend in less overwhelming environments.
Allow Repeating Levels / Minigames / Sections
This is less about addressing an accessibility barrier, and more to do with supporting the ability to play your game in a way that might be best for an autistic player, I’d love to see more game developers actively offer the ability to replay specific levels, sections, minigames, or fights from their game at a later point.
This could either be supported by menu options to return to previous parts of a game, or simply making it easy to have multiple save files during a playthrough, so that returning to a previous save repeatedly is possible.
A lot of autistic people find specific joy in repetetive actions, repeated tasks, and repeatedly revisiting things we enjoy, over and over, as a form of stimming. Stimming is self stimulatory behaviour, using repetition as a way of calming and recentring in an overwhelming world.
Sometimes stimming looks like rocking back and forth or flapping your hands. Sometimes it looks like replaying your favourite 10 minutes of a video game over and over, and I’d love to see more games make efforts actively to support that.
Struggling with Multi-Step Tasks or Multitasking
One aspect of living with autism that isn’t often discussed in conversations around accessibility accommodations in tech is the cognitive load experienced by autistic individuals when processing multiple step tasks, or attempting to multitask information processing.
In terms of multi-step processes first, myself and many other autistic people struggle with initiating tasks without a clear understanding of the steps that are going to follow, and how they will lead to an ultimately completed task. Starting a task without a clear sense of how to complete it, how many steps there will be involved, how long it will take etc is a stressful degree of uncertainty.
In real life the solution to this is usually allowing autistic people to ask clarifying questions without treating that as them questioning the authority of the person assigning the task. In video games, an alternative solution might be offering players a toggle to show what all the sub steps on a quest are going to be in advance.
If a sidequest starts by sending the player to fight one individual enemy, but is going to sprawl into a multiple hour chain of events involving tracking down enemies based on vague photo clues, and at points will lock the player into lengthier sections where they’re unable to switch tasks, that sort of information being able to be revealed in advance could help with making decisions about when to play that content in a way that will be less stressful.
In regards to multitasking, many autistic individuals struggle with processing multiple tasks at once, or being expected to unexpectedly and rapidly drop one task and move to another. The way I try to explain this is that, for me, it feels like when I get deep into a particular task or activity wires start connecting between my brain and the task. Switching tasks or doing something else at the same time means taking a moment to safely disconnect those cables so they can pause data transfer, or free up bandwidth to try and process something in parallel. It’s not as easy as yanking a handful of cords out, they need unplugging carefully which can take a moment.
In terms of ways developers can design around this, finding ways to set expectations up front about task switching can be useful. Recognise this can be a barrier, and if your game relies on sudden and frequent task switching as a core gameplay element, maybe warn players that’s something present in the game so they can make informed choices before purchase.
Exit Ramps for Compulsive Players
Over the past few years, “addictive” has become an increasingly common marketing term used to imply, as a positive, that a game is hard to put down once you start playing. At its best this might mean a game is great with lots of replay value, but at its worst it may simply mean a game is doing a good job of causing addiction, with a gameplay loop that makes it genuinely hard to walk away from.
The latter example, while sometimes a recipe for a game that might be enjoyed, can make certain games incredibly hard for players with obsessive or compulsion prone cognitive disabilities to walk away from.
Players who are prone to, for example, obsessively collecting sets of items, trying to max out levels, or check every possible spot for collectables, may find certain games difficult to put down. As an autistic person, this can lead to me at times playing a game longer than intended, causing issues in my personal life. Addiction as a negative aspect of games.
One thing I try to encourage game developers to consider in their design is exit ramps, to give compulsion prone players clean and easy places in the gameplay loop to pause and come back another day. Examples of this could include the recent release of Elden Ring: Nightreign with its sub one hour roguelike runs having a clearer exit point than the base game of Elden Ring, where a player might “one more try” a boss for multiple hours without a clear exit opportunity.
Overlaps with Comorbid Conditions
Disabilities rarely occur in isolation, and there are a large number of cognitive and physical disabilities that occur at statistically higher than average rates in the autistic community.
While these comorbid conditions and their accessibility needs are not directly connected to the autism diagnostic criteria, their overlaps are common enough that to support the autistic community, you ideally need to keep some other communities’ needs in mind also.
Below are some examples that are not an exhaustive list and not explored in depth, but a starting point for additional research.
Dyspraxia and Coordination Disabilities
Conditions such as Dyspraxia impacting spacial awareness, fine motor control, and coordination consistency are common in the autism community, meaning that motor control accessibility often helps the autistic community.
Hyperactivity and Impulsivity – ADHD
ADHD has a statistically high overlap with autism, meaning that considerations around players with poor memory, lack of focus, and physical hyperactivity are important. Consider options such as pinning screenshots to maps in games like Prince of Persia: The Lost Crown, or options to turn off button press to skip through text, for players who might absentmindedly button mash and accidently miss text.
Additionally, predatory microtransaction practices are more likely to impact players with impulsivity condition overlaps such as this, increasing the importance of not taking advantage of compulsion prone players.
Epilepsy
As previously mentioned, photosensitive epilepsy is fairly common in the autistic community. Designing your game to inherently remove common photosensitivity triggers is important, and can be done with the help of tools like the open source EA program IRIS.
Additionally, offering warnings before visually intense scenes can also be helpful.
Stomach Issues
Autistic individuals often suffer from a variety of stomach issues such as IBS. The ability to pause a game at any time is particularly important given the possibility a player may need to use the bathroom unexpectedly.
Ehlers Danlos Syndrome
A connective tissue disorder, EDS is very common in autistic individuals, and can impact everything from frequency of joint dislocations to general pain and fatigue.
Offering players options to avoid motion controls, reduce button mashing, and turning holds into toggles etc can all help those at this intersection.
While not fully comprehensive, my hope is that this video can serve as a starting point for considering the ways in which accessible design for autistic gamers encompasses a lot more areas of accessibility than most people initially consider in design conversations.
While there are other autism symptoms that game design could perhaps find ways to accommodate, this should help as a starting list of considerations for ways gaming today could be better accommodating to autistic players, with a little bit of focus and attention on our needs as a community.
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